Problems with concentration, restlessness and impulsivity: ADHD and ADD are being diagnosed more and more frequently in adults. A fad? Experts do not assume this – and explain when therapy makes sense.
It’s a switch between turbo mode and total blockage. This is how many sufferers describe the symptoms of their attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD). New figures on diagnoses in adults have now been published in the German Medical Journal. They are based on an evaluation of data from the Central Institute for Statutory Health Insurance.
According to this, the number of AD(H)D cases diagnosed for the first time in adults in Germany increased almost threefold between 2015 and 2024. Today, out of 10,000 people with statutory health insurance, around 26 are newly diagnosed with AD(H)S every year; in 2015 there were only nine.
Young adults under the age of 40 are particularly affected. Significantly more diagnoses have been made among them in recent years, especially among young women, who have caught up significantly in this age group.
Lange underdiagnosed
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According to experts, the fact that there are so many more diagnoses in adults is not because there are more people affected. Instead, ADHD and ADD have long been underdiagnosed, especially in adults.
A main reason could be that until a few decades ago it was assumed that AD(H)D did not occur in adults and that it “grew” after childhood. It was only in the 1990s that a diagnosis for adults slowly became established.
“It can be assumed that many of the cases diagnosed here are delayed diagnoses,” says Swantje Matthies, head of the working group on ADHD and borderline personality disorder in adults at the Freiburg University Hospital. “This means that those affected were already affected in childhood but were not diagnosed. Now they are diagnosed ‘late’ in adulthood.”
Women have been underdiagnosed for a long time
The fact that young women are now being diagnosed more frequently is not necessarily because more women are actually affected. Rather, the symptoms of ADHD and ADD in women were often overlooked for a long time.
The early studies on the topic were based – as is so often the case in the health system – almost exclusively on data from boys and men. This is why typically male symptoms were long considered generally typical AD(H)D symptoms.
We now know that AD(H)D manifests itself differently in women and girls, not always, but often, than in the male gender. They are more likely to be dreamy and inattentive than hyperactive and impulsive. “Girls and women are diagnosed less often in childhood because their symptoms are often less noticeable. That’s why young women are now making up for the diagnosis more often,” says Swantje Matthies.
Not just hype
The topic of AD(H)D has become increasingly present on social media in recent years. This is one of the reasons why young adults realize more quickly that they could be affected.
However, experts do not assume that the large increase in diagnoses is largely a fad and misdiagnosis. “Self-diagnoses certainly lead to diagnoses from the medical system being requested. However, it is not permissible to derive hype or a pathologization of normality from this,” says Andreas Reif, director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy at the Johann Wolfgang Goethe University in Frankfurt am Main.
Diagnosis still difficult
There are estimates that AD(H)D affects approximately 2.5 percent of the entire adult population. The fact that there are now more new diagnoses in adults is seen as a sign that the symptoms are now also recognized as such in adults.
Overall, ADHD and ADD may still be underdiagnosed. “The diagnosis and care of adults with ADHD is still not satisfactory in Germany: diagnosis is often only offered in special consultations and these are largely overloaded,” says Oliver Hennig from the Central Institute for Mental Health Mannheim.
Symptoms different than in children
The main symptoms of ADHD in adulthood are inner restlessness, the feeling of never being able to switch off and constantly putting off tasks that seem monotonous and not completing them. Those affected report, for example, that they cannot concentrate in meetings or when reading, that they constantly forget appointments and that household chores or arranging finances are very chaotic. Interpersonal problems, such as the constant need to interrupt others or react very emotionally quickly, are also mentioned.
Sometimes those affected also experience restlessness and a constant need to be busy. Compared to ADHD, ADD lacks this hyperactivity. Overall, adults with ADHD are less hyperactive and impulsive than younger children. This is partly because over time they have developed strategies to cope with this in everyday life.
Therapy is not always necessary
Therapy is not always necessary after a diagnosis. Because some people cope well with their ADHD. The symptoms vary in severity among those affected – which is why the disorder is also understood as a spectrum. And it can even have advantages because people with ADHD, for example, can go into so-called hyperfocus and work with extreme concentration if they are interested in a topic.
Medications work more reliably
But if you are suffering, it is worth considering medication. A recently published meta-analysis compared the effectiveness of different treatment options for adults. After that, only medications such as methylphenidate, which is primarily known under the brand name “Ritalin,” or amphetamines help reliably and quickly against the core symptoms of ADHD, i.e. restlessness, inattention or impulsivity.
Other forms of therapy, such as psychotherapy, behavior change or neurofeedback, have shown variable results and, overall, helped later and to a lesser extent. Such non-drug procedures are still sometimes important in therapy, says Marcel Romanos from the University Hospital of Würzburg: “Secondary problems such as relationship problems, reactive fear, social conflicts at work, problems in raising children, aggressive behavior, but also secondary physical illnesses are often in the foreground in the course of the disease and can often be treated with psychotherapy.”
Medical diagnosis required
For all forms of therapy, it is important to seek medical advice and, especially with drug therapy, to have a diagnosis that conforms to guidelines. Many of the medications prescribed act like stimulants in people without ADHD and can cause serious side effects.